Objective · To explore the value of cervical transformation zone (TZ) type in assessing whether a random biopsy should be used to diagnose high-grade squamous intraepithelial lesion (HSIL) among patients without visible lesions under colposcopy. Methods · A total of 517 patients who underwent colposcopy (without visible lesions) due to high risk subtype infection of human papillomavirus (HPV) or thinprep cytologic test (TCT) abnormality were enrolled. TZ types were identified, random biopsies were performed, and the value of TZ typeⅠ, Ⅱand Ⅲ in the diagnosis of HSIL was evaluated. Results · There were 517 cases without visible lesions under colposcopy. Three hundred and ninety-six of them were TZ type Ⅲ , and the detection rate of HSIL was 3.8% (15/396) by random biopsy, while one hundred and twenty one of them were TZ type Ⅰ and Ⅱ, and the detection rate of HSIL was 8.3% (10/121). Compared with the TZ type Ⅲ, the detection rate of HSIL in the TZ type Ⅰ and Ⅱ was significantly increased (P=0.000). Logistic regression showed that TCT abnormality, TZ typeⅠ and Ⅱ were the risk factors for HSIL detection in patients without visible lesions under colposcopy. Conclusion · Random multipoint biopsy can significantly increase detection rate of cervical HSIL when no visible lesion is visualized under colposcopy, particularly in women with abnormal TCT results or TZ type Ⅰ and Ⅱ.